The board of directors in charge of the virtual marketplace called the Health Insurance Exchange reluctantly voted in favor of increasing insurance deductibles for hospital visits and drugs at its monthly meeting Thursday.
The hospital visit offered as part of the “silver” plan, which is the second lowest of the various plan tiers offered on the exchange, increased from $2,500 to $3,000 and the pharmacy deductible went up to $500— even though the board expressed a desire to get it down to $400. That’s on top of what has been estimated as monthly premiums as high as between $300 and $700 per month and before co-pays for doctor visits. Exact monthly premium amounts and co-pays won’t be finalized until later this summer after the participating insurance carriers submit their proposals.
An analyst for the exchange, which is re-branding itself as Access Health CT, said the new actuarial valuation calculator from the federal government prompted the increase in deductibles to meet the mandated actuarial value spelled out in the Affordable Care Act.
“The calculator has nothing to do with affordability,” State Healthcare Advocate Victoria Veltri pointed out.
Veltri said she would like to know what the increase means for “real people.“
She cited a new report by the Connecticut Health Foundation that found the 37,000 parents Gov. Dannel P. Malloy’s budget kicks off the state’s HUSKY plan, who currently have no premiums or cost sharing obligations, will face premiums, co-pays, and deductibles averaging $1,800 a year.
The report also found an estimated 7,500-11,000 parents would not purchase subsidized health insurance through the exchange because of increased out-of-pocket costs – likely ending up uninsured.
But Office of Policy and Management Secretary Ben Barnes, who co-chairs the exchange board, said he doesn’t believe that will be the case.
Barnes said if someone who is at 150 percent of the federal poverty level, then their monthly premium will be subsidized so they will only be paying $78 to $118 per month in premiums and their annual out-of-pocket cost will be capped at $2,000 per year, which is about $150 per month.
Lt. Gov. Nancy Wyman, the other co-chairwoman of the exchange, said a parent would only reach that $1,800, if they were seeking a lot of treatment.
But the Connecticut Health Foundation report concludes that if a single mother of two children, who makes $29,646 a year, which is 180 percent of the federal poverty level, currently has about $300 per year in medical expenses, her out-of-pocket cost on the exchange would be about $1,634 or 5.6 percent of her annual income.
Barnes estimated that out-of-pocket costs for a HUSKY parent, who will be forced starting in Jan. 2014 to purchase their insurance through the exchange, will be between $75 and $250 a month.
“I’m not saying it’s easy, but those are well-below the costs that people face today,” Barnes said.
The standard plan design the exchange adopted Thursday also says if you’re pregnant and receiving care from an OB/GYN then you have to pay an increased co-pay because during that time they’re considered a specialist. Many women choose their OB/GYN as their primary care provider, but this will only impact a woman during maternity services.
“That’s discriminatory,” Ellen Andrews, executive director of the CT Health Policy Project, said.
She said she doesn’t understand why treatment of a pregnant woman and her unborn baby wouldn’t be considered preventative.
Department of Social Services Commissioner Roderick Bremby said pre-natal visits are something that plan should be encouraging. He fears a higher co-pay would encourage pregnant women not to visit their doctors.
Mary Fox, another member of the exchange, said she feels like the increase maternity co-pay files in the face of the underlying intent of the Affordable Care Act.
Andrews, who represents low-income clients in the healthcare market, said people who are uninsured now can’t afford what’s on the market. She said the richness of the plans the exchange is mandating are only going to exasperate the problem.
Grant Porter, a senior analyst with the exchange, said the federal government made the rules and the state really doesn’t have the option at the moment to make changes, if it wants to be in compliance with the Affordable Care Act.
The board adopted the proposed changes Thursday, in part because it won’t meet again before it gives the parameters of the plan over to insurance carriers. The insurance carriers will then submit their proposed plans to the exchange and the Insurance Department by the end of April. The benefit plan won’t be finalized until later in the summer, after the legislature is expected to adjourn.
Barnes there’s concerns premiums will go up because the plans in the exchange have more generous provisions than some of the plans that are currently offered outside the exchange.
“We’re certainly struggling against that,” Barnes said. “It’s very difficult to provide everything at no cost.”
